Laparoscopic Choledochal Cyst Excision and Hepaticojejunostomy: A Case Series

Abstract

Purpose: Choledochal cysts are congenital dilatations of the biliary tract and are generally surgically excised. Laparoscopic total excision of choledochal cysts and hepaticojejunal biliary tract reconstruction has gained acceptance among pediatric surgeons. We report our early experience with this procedure. Methods:From May 2013 to April 2016, 10 consecutive patients (7 females and 3 males) underwent laparoscopic choledochal cyst excision and hepaticojejunostomy at our center. We retrospectively reviewed their medical records for age, sex, clinical symptoms, Todani classification, anomalous pancreaticobiliary duct union, operative time, starting day for enteral feeding, complications, and hospital stay. Results:The median patient age was 22 months. Four patients were aged less than 6months, 3 of whom received prenatal diagnosis using ultrasonography. Patients presented with abdominal pain, jaundice, vomiting and fever. No abdominal mass was palpated in any patient. One patient was classified as Todani type Ia, 4 as Ic, and 5as IVa. Six patients had an anomalous pancreaticobiliary duct union. The mean operative time was 319.4 minutes. There were no surgery-related complications. Sips of water were allowed from mean postoperative day 2.4 and regular diet from mean postoperative day 3.4. The mean hospital stay was 6.5 days. Conclusion:Laparoscopic excision of choledochal cyst and hepaticojejunostomy in children is feasible with favorable cosmesis.

Tratamiento laparoscópico de un quiste de colédoco gigante en un paciente pediátrico

“…Por todo lo anterior, el abordaje laparoscópico no se ha recomendado para los pacientes con quistes de colédoco gigantes ≥ 10 cm. Incluso, en algunos reportes se menciona que el tamaño de la cavidad dificulta la disección y el tratamiento laparoscópico 13,14 . Asimismo, algunas publicaciones mencionan que se requiere la conversión a cirugía abierta para los quistes gigantes 15 .…”